Renin-angiotensin system blockade and contrast-induced renal toxicity.
BACKGROUND
The influence of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) on contrast-induced renal toxicity has been poorly studied. Nevertheless, it is a common practice in many centers to stop these drugs before coronarography. Our goal was to study whether renal function was affected in patients taking ACEIs or ARBs and undergoing a coronary angiogram.


METHODS
Patients on ACEIs or ARBs (n=17) and those not on ACEIs or ARBs (n=18) admitted for a coronary angiogram underwent glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) assessment either by isotopic clearances (51Cr-EDTA and MAG3) or inulin and paraimmuno-hippurate clearances 24 hours prior to and immediately after coronary angiogram.


RESULTS
Median percentage GFR changes induced by the injection of contrast medium during coronary angiogram were -9% (interquartile range -19% to +3%) in the control group and -1% (interquartile range -9% to +39%) in the ACEI/ARB group. Mean ERPF remained stable after coronarography in the control group (median change -8%; interquartile range -18% to +6%) and increased slightly in the ACEI/ARB group (median change +9%; interquartile range -17% to +60%). The median percentage difference in EPRF change was not statistically significant between the 2 groups (p=0.18).


CONCLUSIONS
Inhibition of the renin-angiotensin system is not associated with a decline in renal function in patients receiving contrast media, and there is no need to interrupt this treatment prior to coronary angiogram.
Saudan
Patrick
P
Division of Nephrology, University Hospitals of Geneva, Geneva - Switzerland. Patrick.Saudan@hcuge.ch
Muller
Hajo
H
Feraille
Eric
E
Martin
Pierre-Yves
PY
Mach
François
F
D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011866:Radioisotope Renography; D017597:Renal Blood Flow, Effective / Q000187:drug effects
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D003287:Contrast Media